Clinical Pharmacy Forum
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Service or Program:
Local inpatient fluoroquinolone (FQ) use guidelines for treatment of urinary tract infections, pneumonia, skin-soft tissue infections and diabetic foot infections were developed. In June 2019, a prospective audit and feedback (PAF) process was implemented for the clinical pharmacist at time of order verification. Pharmacists contacted the prescriber and recommended an alternate agent based on the infection or contraindications according to local FQ guidelines.
Justification/Documentation:
The FDA advised restricting FQs in treatment of uncomplicated infections when risks of side effects outweigh the benefits. FQ use has been high at our institution. According to local antibiogram, FQ susceptibilities to Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis were low and empiric use was not recommended. In 2017, “Inpatient Fluoroquinolone Use” pocket cards with guidelines were developed, distributed, and education was provided to inpatient resident medical teams. Education efforts alone were not sufficient to impact use. This PAF process addressed needs to decrease FQ prescribing.
FQ days of therapy (DOT) per 1000 patient days have decreased [57-(2017), 55-(2018), 28-(2019), 23-(2020), 20-(2021), 22-(2022)].
Ciprofloxacin susceptibility has increased for Escherichia coli [74%-(2017), 79%-(2018), 73%-(2019), 80%-(2020), 81%-(2021), 82%-(2022)], Pseudomonas aeruginosa [80%-(2017), 80%-(2018), 80%-(2019), 86%-(2020), 80%-(2021), 85%-(2022)], and Proteus mirabilis [63%-(2017), 76%-(2018), 69%-(2019), 72%-(2020), 81%-(2021), 83%-(2022)].
Adaptability:
The FQ-PAF program was pharmacist-driven on all shifts. The antimicrobial stewardship pharmacist (ASP) provided education regarding the guidelines and FQ-PAF. The process is readily adaptable to other medications or disease states in order to improve medication management and optimize patient outcomes. It also demonstrates an easily implemented ASP intervention as required by The Joint Commission Standards.
Significance:
Clinical pharmacists had a direct impact on optimizing antimicrobial use for patient care with the FQ-PAF. The program successfully decreased FQ-DOT. Additionally, it may have impacted the antibiogram and increased the possibility of FQs being an option when a FQ is the preferred antimicrobial treatment.
Presenting Author
Pamela A. Foral Pharm.D., FCCP, BCPSCreighton University School of Pharmacy and Health Professions
Authors
Marvin Bittner MD
Veterans Affairs Nebraska-Western Iowa Health Care System
Gary Gorby MD
Veterans Affairs Nebraska-Western Iowa Health Care System
Kelsey Witherspoon MD
Creighton University School of Medicine
Jennifer Rother Pharm.D., BCPS
Veterans Affairs Nebraska-Western Iowa Health Care System